​CD, Re (Treatment: Haemodialysis) [2024] EWCOP 55 (T3)

Application for declarations that it was not in CD's best interests to have new haemodialysis catheter fitted and that he should instead receive palliative care.

CD, a 66 year old originally from Bangladesh,  has end-stage renal disease and other conditions. There was a problem with his catheter but an attempt to insert a long term tunnelled catheter failed because CD was too agitated and he repeatedly attempted to pull it out. There was no dispute the temporary catheter should be removed but given the difficulties, the NHS Trust submitted he should receive palliative care. The professional evidence was that without the dialysis he was likely to live for another two weeks whereas if treatment continued he could live for 3-6 months. 

Poole J, however, rejects the application. While the difficulties are an important factor he states at [29]

"The presumption that steps should be taken to preserve life, the family's views, evidence as to CD's beliefs and values and his past wishes and feelings, and the evidence of the pleasures that he still derives from interactions with his family and others and from good food, weigh in favour of his undergoing the procedure and continuing with dialysis. I am cautious about finding that it is in his best interests to undergo a procedure the purpose of which he might unknowingly frustrate by pulling out a catheter, but without the insertion of a catheter his life cannot be preserved, and his life, if preserved, will continue to bring him real benefits alongside its burdens. There is no advanced decision to consider but the evidence is that CD is a man who, if he still had capacity, would not want his life to end prematurely unless its burdens became wholly overwhelming."

Read the judgment on Bailii